Wednesday, December 28, 2011

Infinite Inspiration

Recently I finished one of the most inspiring books I have ever read, Infinite Vision by Big Sis Pavi and Suchi. Reading the book now was very timely for me personally as I try to build an organization trying to bring about social change in India. But that's at the surface level. At a deeper level I learned about the nature and personality of a deeply spiritual person driven by the cause of human welfare. How he lived, how he thought, how he acted.

Aravind, in my mind, is the pinnacle of so-called social enterprise. It represents the heights an organization can achieve in terms of excellence, growth, and notoriety as it relentlessly pursues compassionate service to the poorest of the poor. The first few pages presented a bold and improbable claim: Aravind had worked out a model in which the more they went out of their way to serve the poorest of the poor, the better it was for business. Sounds like a parlor trick. How can you earn more by optimizing yourself to reach those who have no money?

My interpretation of the book's explanation is this: Aravind was driven to provide high-quality eye care at the cheapest possible cost to customers ($0). In that drive it had no choice but to find ways to make the costs of delivering that service as low as possible. The constraints demanded they get creative. The response: get less, do more. It engaged in two classes of radical innovation: process and technological. In a service traditionally requiring significant attention from highly skilled but low-supply personnel, it used the (in)famous McDonald's "hospital-as-a-factory" [18] process approach to substitute for the human touch. With the right recruiting and training in its paraprofessional program, they were able to retain the compassionate care ethos even with this switch. The devotion to process and systems thinking allowed surgeons to do massive volumes of high-quality surgeries, which drove down per-surgery costs (surgeons were paid a flat salary, fixed costs better amortized).

The second class of innovation was technological. In what I consider the masterstroke breakthrough of the Aravind Eye Care System, they brought the manufacturing of intraocular lenses (IOLs) to India, and using clever home-brewed methods brought the costs of those lenses down from $200 to $5. That was the fundamental building block for cheap cataract surgery. So simple in hindsight, but what a bold ballsy move at the time. This is the type of leap-ahead thinking that separated Dr.V from the rest in his field.

The cheap IOLs powered what I consider the engine underlying the serving-poorer-people-is-better-for-business model: they didn't sacrifice quality of service any step of the way. At the time surgery for cataracts using IOLs was the state-of-the-art, only it was considered unaffordable for developing countries. Aravind broke that mainstream thinking.

In the end they solved the market demand problem by providing a service that was so high-quality that even though they were driven to provide it to poor people, rich people couldn't help but seek it as well. And so with that demand-pull force and a pricing strategy that respected the choice (and therefore dignity) of each individual, they got the rich to cross-subsidize the costs for the poor.

This model is very compelling. Provide a service that everyone needs, and provide it with uncompromisingly high quality. Then get rich people to pay enough for it that you can provide it cheap to poor people. Aravind generated enough surplus through this model to bootstrap its own growth. There's nothing more natural and validating than an organization growing purely on the fruits of its own efforts. At Aravind's first hospital each subsequent floor was built only after it had enough money to pay for it. They literally grew the organization brick by brick. And grow it did, to an eye care ecosystem including hospitals, rural vision centers, eye camps, international management consultancy, post-grad medical training programs, manufacturing, research institute, over 30 million patients served, over 30 countries consulted, nearly $30 million in yearly revenue. And it remains a registered non-profit organization.

Aravind has deeply influenced my thinking about my own organization. Following its example, Awaaz.De aims to provide a service so good that organizations with money will be willing to pay for it, while making it affordable and accessible and appropriate for the underserved communities we are mission-driven to serve. I have made Infinite Vision required reading for all Awaaz.De employees. A copy sits in our office library. Aravind is a paragon, an inspiration for how to run a social enterprise with integrity and compassion and focus, and also financial sustainability.

Others who've read the book have also been inspired. Big John, a regular attendee of Wednesdays in Santa Clara, a lovely warm presence with deep wisdom, told me the book was also timely for the healing of the world at this particular point in history. While reading it, he told me how much awe he had for Pavi and Aravind and how he was on the 8th chapter but "didn't want it to end". Later I talked to Shariq who said he had started reading the book from the back because he was anxious to know how the story ends: how was Aravind affected by Dr.V's passing? As a researcher interested in the longevity and legacy of institutions and their values, this was the part of this rich tapestry story that he was most anxious to delve into.

The beauty of this story and the way Pavi has woven it together is that there is something in it for everybody. There were so many features, fun and touching little anecdotes, and quotes that I loved, especially ones that revealed the personality of Dr.V and the culture of Aravind. I've compiled a few below, maybe I'll keep adding to the list. I hope it gives a sense of the spirit of this book, and the people and organization it portrays.

I have never read a book in which the cast of characters were presented in a family tree on the first page. I enjoyed the "meet the family" section, and that you had to constantly reference it while reading the book. As got into the story, the family members, particularly the founding team, grew into giant superheroes in my mind's eye. Each had their special powers. Dr.V the visionary, Natchiar the stern disciplinarian, leader, and accomplished surgeon, Thulsi the management czar, Srinivasan the resource and facilities genius, etc. They all had their gifts and came together and complemented each other like X-Men.

Dr.V's understated way of giving praise: "Very good, very good" [250]. I hear him saying it and chuckle.

I loved learning about the family dynamics, the challenges of transitioning leadership and culture through generations, the family/non-family ingroup/outgroup tensions, and how the younger generations related to and perceived the elders. Dr.V's New Age Group meetings were genius, a way to build solidarity and create "memories of caring that would outlast his lifetime" [249]

Natchiar: "…The West talks about 'value addition'. I don't know that that means. When a nurse holds an elderly patient's hand and leads her where she needs to go- to me that is value addition." [96]

Dr. V lives 3 minutes away from the hospital. He goes to his office every morning at 7am. He drives himself down the street, and being a cautious driver, honks most of the way [132]

After Dr.V observed Natchiar berating a janitor: "Did you shout at his body or at his soul, Natchiar? Shout at his body. His soul belongs to God. If you shout at his soul, you are shouting at God." [138]

Out of tens of thousands of journal entries, Dr.V rarely used a question mark. "As if framing the right question is itself an answer of sorts." [18]

Dr.V was invited to Harvard University to give a talk titled, "Living a Spiritual Life in a Contemporary World." He wore an ill-fitted brown suit purchased from a thrift store.

Dr. V's sandals. How he spears them with his walking stick to slip them on and off his gnarled toes; green and red rubberbands snapped onto the toe-holds to mark the two pairs he owns in order to avoid wearing either pair out too quickly. "A trivial detail loaded with his distinct personality: his utter lack of vanity, his frugality, his passion for order and discipline in the smallest details. He has built those qualities into his family and into Aravind." [57]

Sweet and simple Dr.V quote on mentorship, the last phrase always makes me smile as I think of him saying it in his accent: "Just as you are training somebody for the Olympics, you train everybody every day. You coach him, guide him, and play with him. So you can develop him quickly as a top player." [103]

Very interesting insight on the patience and egolessness required to build an organization like Aravind. Dr. Aravind: "You know, Dr. V built this place at the right time. He wasn't competing for anything at that stage in his career… you have to be completely out of the rat race to build an institution like this." [93]

One of my all-time favorite Dr.V quotes, captured in the documentary (min 7:26) and spoken in his sweet, endearing, matter-of-fact way: "And I don't insist upon that that man must pay me before I do anything for him. I say, give him the sight man, let him give whatever he can give. If he cannot afford, doesn't matter, he can give later."

Am super-excited by your review! I'm halfway through the book, and just yesterday read the part where Dr. V says: "Did you shout at his body or at his soul, Natchiar?" I was stunned. A number of the sentences I have underlined in the book until now match those you write here :) Thank you for the reminder!!